P! Phenotyping - Exam 2 Flashcards
are stiff areas always painful when you have hypomobility? what happens if it’s not addressed?
No, but if not addressed, it will usually cause painful hypermobile compensations elsewhere –> the path of least resistance
stiff facet leads to hypermobile ______ ________
adjacent facets
stiff/hypomobile upper thoracic region leads to ___________ low ______ spine
hypermobile; cervical
how do you get more uniform/distributed motion?
mobilize stiff areas
are hypermobile areas usually painful? why or why not?
yes because the axis of motion is less controlled
which muscles are better to control motion to stabilize hypermobile areas?
smaller and deeper muscles
what must you make sure to do when treating hypermobility?
look at adjacent regions
what does the orientation of facets determine? (2)
direction and amount of motion
what part of the C spine favors all motions rather equally?
C2-C7
what planes are C2-C7 between?
frontal and transverse
what plane is upper thoracic region in?
mostly frontal plane
what motion does the upper thoracic region favor? what limits this motion?
favors SB but ribs limit SB
presents with more RT because of SB limitation
what are the four variables for stabilization?
joint integrity i.e., cartilage, bone, capsule
passive stiffness i.e., ligaments (non contractile)
neural input –> conduction of nerves, fibers recruiting
muscle function
describe local muscles
– (farther/closer) to axis of motion
– deeper/shallow
– stabilization > or < rotatory forces
– ____ muscles
– aerobic > or < anaerobic
– Type??
stabilizers
– closer to axis of motion
– often deeper
– stabilization > rotatory forces
– shunt muscles
– aerobic > anaerobic
– tonic/postural
describe global muscles
– closer/further from axis of motion
– superficial/deep
– rotatory > or < stabilization forces
– _____ muscles
– type?
– anaerobic > or < aerobic
“mirror muscles”
– further from axis of motion
– often superficial
– rotatory > stabilization forces
– spurt muscles (better movers)
– phasic
– anaerobic > aerobic
what are the cervical local muscles?
longus colli and other deep neck flexors
suboccipitals and splenius mm
what are the thoracic local muscles?
rotatores and multifidus - if smaller = higher injury rates
pelvic floor and transversus abdominus - increases contraction of multifidus
what does pain, swelling, joint laxity and disuse in local muscles cause?
- decreased and delayed motor activation and coordination (aka inhibition)
- inhibition preferential to type I muscles
- supply lowered which can lead to more easily overworked muscles even without doing more –> more stress on passive structures
- local muscle atrophy and strength declines along with loss of every other muscle function
- increased stress on non-contractile structures
what does pain, swelling, joint laxity and disuse cause in global muscles?
- increased and inefficient motor activity
- decreased cervical proprioception and kinesthesia (position and motion sense)
- atrophy leading to fatty infiltration >50% of muscle cross sectional area is fat (local) and >60% (global)
- fiber transformation - type I change to type II (less able to do what the muscle is designed for)
true or false. normal muscle activity returns spontaneously even when pain is gone
false
normal muscle activity doesn’t return spontaneously even when pain is gone
what percentage of muscle activation is sufficient to keep stability and improve muscular endurance?
30% - it doesn’t take a lot
what is pain phenotyping? (types of pain)
set of observable pain characteristics of an individual resulting from body and environment interaction
- more info for where the pain is coming from
what is nociceptive pain phenotyping?
NON-nervous tissue compromise
MSK including spondylogenic (ligament, muscle)
viscerogenic - organ dysfunction, pain from it
what is neuropathic pain phenotyping?
nervous tissue compromise
- radicular
- radiculopathy
- peripheral - worst one. pain gets worse going down the extremity (peripheralization)
what is nociplastic pain phenotyping?
altered pain perception without complete evidence of actual or threatened tissue compromise
what is spondylogenic P! (from the spine) and is it common?
something in the spine may be injured
local and/or referred spinal P! from noxious stimulation of spine structures
- yes, common
can spondylogenic P! cause visceral dysfunction?
No
what are symptoms of spondylogenic P!
Non-segmental pain – not from a spinal nerve
rarely if any paresthesia’s
vague, deep, achy, boring P!
referred into ill-defined area that settles into a consistent location
what are signs of spondylogenic P!
neuro scan WNL
can’t reproduce entire symptom pattern with motion
describe somatic convergence or referred P!
is it common?
sensory afferents converge on and share same innervation
(joints innervated by muscles in that region - pain spreads through innervation)
is there a greater referral of proximal and deep structures OR distal and superficial structures? give example in the body
proximal and deep structures
ex: spinal facets refer more than elbow joint
what is viscerogenic p!
referred P! from an organ
what is viscerosomatic convergence?
viscera and somatic (body) sensory afferents converge on and share the same innervation
* organ pain can cause muscle pain
give an example of viscerogenic P! in the body
heart can refer to L shoulder, UE, neck, jaw
because ALL innervated by C4-T4 spinal nerve
what are S&S of viscerogenic P!
not typically able to be mechanically reproduced
neuro scan WNL
what is radicular P!
ectopic or abnormal discharge from highly inflammed spinal nerve (dorsal root)
what are symptoms of radicular P!
lancing
electrical shock like P! along an extremity in a narrow 2-3 inch band
what are signs of radicular P!
dermatomes, DTR, myotomes - WNL
- may be difficult to localize segment if acute/mild - takes time for hypo activity to show
+ dural mobility tests due to high inflammation
NOT common
imaging helpful for involved spinal nerve
what is radiculopathy?
more persistent blocked conduction of spinal nerve due to compression or inflammation
what are symptoms of radiculopathy?
segmental parethesia’s - decreased sensation of light touch (spinal nerve impaired)
- often constant and long duration
- slow progression to ill defined area due to dermatomal overlap (hangs around)
possible weakness (myotomes) - remember you need 80% conduction loss before + test (significant loss)
what are signs of radiculopathy?
neuro scan + for segmental hypoactivity
imaging helpful for involved spinal nerve
what is peripheral nerve pain phenotyping?
decreased conduction of nerve branch
i.e. median nerve with carpal tunnel syndrome
peripheral nerve = numbness
what are symptoms of peripheral nerve?
non-segmental paresthesia
- often intermittent and short duration
- fast progression to well-defined area of numbness because of overlap of peripheral nerve (unlike spinal nerves)
possible weakness
what are signs of peripheral nerve pain?
dermatomes, DTR, myotomes WNL
non-segmental hypoactivity
- decreased sensation along peripheral nerve distribution
- possible weakness of muscle innervated by peripheral nerve
+ dural mobility tests –> inflammed nerve
